A 43-year-old patient of mine called me on Friday, to tell me that she wasn't able to have the mammogram that I ordered. Puzzled, I asked why. She told me that her husband had done some research on the Internet, was worried about her radiation exposure, and told her that she wasn't allowed to have a mammogram. Let me repeat this: he told his 43-year-old wife--and he meant it--that she wasn't allowed to have a mammogram, against her doctor's recommendation.  

Why, you may be asking incredulously, would he say this? My patient has a long history of fibrocystic breast change. She's had several suspicious breast lumps in the past, and has received multiple mammograms to make sure that she didn't have cancer. When I examined her last month, I found a lump that I thought was worth a closer look, so I gave her a referral for another mammogram. It's the cumulative effect of all of those tests that is worrying her husband.

I decided to start with the facts first. I reassured her that while X-rays do carry a small risk, that risk is greatly overwhelmed by the benefit of early detection of breast cancer. And I emphasized that the Internet is both a great source of information, and the biggest fear factory of all time. And knowing that they both wanted more info, I sent her (and him) here and here and especially here.

But accurate information is only the surface. I can understand his fear of losing his wife, and wanting her to be safe. I get it--cancer is scary. He could have come in to my office with her, or called me, or even emailed me, to discuss his "research" and to share his concerns. But he didn't. This isn't about radiation, this is about control. I CANNOT understand that he thinks that he has the right to dictate what his wife can do with her body. She is not his daughter (though his control would be limited there too), she is his partner. And even if he completely disagrees with her decision, in the end the decision is hers to make. I know my patients are (mostly) grown-ups, and I never want to impose my judgment on their decision-making. But there are so many factors that determine whether or not a patient will get the care she needs: if she comes in to see me...if I'm smart enough to figure out how to treat her...if she can afford the treatment...if she can get time away from work and home to get it...and how many barriers (including spousal) she needs to jump to get there. I can't change most of these things, and that makes me feel downright paralyzed. Even as a doctor, you can feel powerless.

Ultimately, she decided to go for the mammogram anyway, which she had already scheduled for Monday. She told me, "He's just going to have to learn to accept it." I'm happy with her decision, but now I'm worried about two things--her test results, and her husband's reaction. What do you think?